Traumatic Brain Injury Medicaid Waiver

The Hamaspik “TBI Waiver” program includes a broad range of support and individualized services, paid for by Medicaid under a special “waiver” specifically designed to enable people with TBI to reside at home instead of being institutionalized.

“Waiver” means the federal government “waives” certain rules, enabling a portion of the population to receive specialized services not available to all Medicaid recipients. In this case, the services are targeted to people with TBI. The term TBI stands for any type of “Traumatic Brain Injury”, such as: aneurysm, stroke, anoxia, brain cancer, fall, accident, poisoning, encephalitis, or any other acute condition that causes a traumatic brain injury.

Hamaspik has developed this program to provide a cost affective, community based, alternative to placement in a nursing facility. With approved Medicaid Waiver, the program provides comprehensive individualized help to meet the specific needs of people with TBI.

In addition to services available through regular Medicaid, individuals determined eligible for TBI Waiver will have one of our TBI Coordinators develop an Individual Service Plan (“ISP”), for each consumer individually, to include any of the services listed below:

• Service Coordination – A staff member at Hamaspik is designated as the participant’s “Service Coordinator” to identify eligible resources and services, implement and maintain them, and advocate on the participant’s behalf.
• Independent Living Skills Training – Provides one-on-one support to focus on increasing independence in practical skills such as house chores, cooking, shopping, banking, etc. 
• Structured Day Program – Provides an environment focused on task oriented activities and social skill building.
• Community Integration Counseling – Counseling is provided to participant and/or family members to assist with community integration.
• Home and Community Support Services – Provides guidance and assistance to enable the participant to live safely and comfortably within the home and community. 
• Intensive Behavioral Program – Provides direct technical assistance to individuals with challenging behaviors, and staff training for development of program support strategies.
• Environment Modification – Provides funding for renovations in the participant’s residence and primary vehicle to promote independence and ensure safety.
• Respite – Provides short term relief to care-givers.
• Medical Equipment and Supplies – Provides funding for durable and non-durable medical equipment (that is generally not funded by Medicaid.)
• Transportation – Provides access to non-medical services in the community.
• Housing – Provides rent subsidies for TBI participants to obtain affordable housing at a fair market value.

To be eligible for TBI Waiver, the applicant must be: Living in New York State, eligible for Medicaid, diagnosed with any type of Traumatic Brain Injury as mentioned above, between the ages of 22 and 64, in need of a nursing facility “level of care”, choose to live in the community rather than in a nursing facility, and indeed be able to live safely within the community with the funds and services available under the TBI Waiver program.

TBI Waiver is relatively unknown in the community, where many patients could benefit from its services. Statistically speaking, traumatic brain injury is more common than one might think. According to the National Brain Injury Association of America, a “Brain Episode” happens every 22 seconds in the United States. About 5.3 million Americans suffer from some form of brain trauma, the Association says

Hamaspik therefore offers this initiative to help the hundreds of families who are dealing with a traumatic brain injury. For more information about the TBI program, call (845) 356-8400 ext. 210. Hamaspik TBI coordinator Mrs. Preizler is waiting to answer your call today.